AccountId: 011433970860
ContactId: 182fbd0e-8d13-49fc-afcf-b4fcccb561b9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 353559 ms
Total Talk Time (AGENT): 148790 ms
Total Talk Time (CUSTOMER): 141746 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/10/182fbd0e-8d13-49fc-afcf-b4fcccb561b9_20250110T14:51_UTC.wav
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[AGENT][POSITIVE] Good Morning, thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, I'm sorry, can I get your name again?
[AGENT][NEUTRAL] Sure. My name is [PII]. That's [PII]. Last initial [PII].
[CUSTOMER][NEUTRAL] Thank you. So my name is [PII]. I am calling from a provider's office. I need to get members eligibility and benefits patients in our office, and we needing to confirm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Sure.
[AGENT][POSITIVE] OK. Yes, Ms. [PII], I can assist you with the eligibility and benefits. And may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Thank you. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Um, yes, ma'am. That is.
[CUSTOMER][NEUTRAL] One second, it shows it's 0161.
[CUSTOMER][NEUTRAL] 2903.
[AGENT][NEUTRAL] All right. What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] [PII] and the patient's date of birth is
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Ma.
[AGENT][NEUTRAL] All right. And you said you need eligibility and benefits, and what type of service is being rendered?
[CUSTOMER][NEUTRAL] Um, I like to know if the patient's insurance is primary or secondary, and because the patient does have another insurance on file, and then also if it is um.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mm, OK.
[CUSTOMER][NEUTRAL] Yes, so patient has Medicare, I believe, no UHC um.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And the services that I need is for a specialist office visit and then minor diagnostic done in office.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, perfect.
[CUSTOMER][NEUTRAL] As well as in-office, oh, it's 5 benefits, so just a few more and then for in office surgery.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] As well as hospital outpatient surgery with the professional fee.
[CUSTOMER][NEUTRAL] And then injections performed in the office, which is the part B.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] And before I give you any benefit information, I need to let you know that this is not a guarantee of payment, just a verification of coverage and that's just a disclaimer. um, this particular policy is a secondary supplemental plan to the major medical.
[AGENT][NEUTRAL] And let's see, we have an effective date of [PII]. It is active at the moment. And let's see. OK. So this one has outpatient, uh, go ahead.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] You said
[CUSTOMER][NEUTRAL] I'm sorry, you said [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] [PII]. OK, thank you.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] All right. And this
[CUSTOMER][NEUTRAL] I'm sorry you were saying?
[AGENT][NEUTRAL] It's OK. Um, this particular policy has outpatient benefits. Um, the outpatient benefit is um 5000 per covered person per calendar year after a, um, deductible of 250. Now, this one doesn't cover anything in office. There's no office coverage at all. This one is just for outpatient facilities, diagnostic centers, surgical centers, urgent care.
[AGENT][NEUTRAL] Those type of places, but it doesn't have any coverage in office or office visits.
[CUSTOMER][NEGATIVE] So no type of perfect because everything, most of the benefits are done in the office, so anything done at the office, it wouldn't be covered.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, so only for hospital outpatient surgery?
[AGENT][POSITIVE] Correct. Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And what would the benefit be for the outpatient surgery?
[AGENT][NEUTRAL] OK. Again, the outpatient maximum is 5000 per covered person per calendar year after a 250% deductible.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK, so patient has to reach their 250 deductible.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And then they get covered at what again?
[AGENT][NEUTRAL] We cover up to $5000 per calendar year for our patient service.
[CUSTOMER][NEUTRAL] Up to 5000, got it.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] And nothing has been met correct.
[AGENT][POSITIVE] No, we start it all over again with you.
[CUSTOMER][NEUTRAL] OK, so hospital outpatient surgery.
[CUSTOMER][POSITIVE] Sounds good. Can I get a reference number? Oh, and the claims address, please?
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] The address to submit claims is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] The zip code is [PII].
[CUSTOMER][NEUTRAL] OK, sounds good. Can I get a reference number?
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name in today's state if you will.
[CUSTOMER][POSITIVE] OK, perfect. Thank you so much. You enjoy the rest of your day.
[AGENT][NEUTRAL] Mm
[AGENT][POSITIVE] US ma'am and thank you for calling APL Ms. [PII].
[CUSTOMER][POSITIVE] Thanks you too bye bye.
[AGENT][POSITIVE] You're welcome. Bye-bye.